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General NPI Number Information
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NPI Number | 1902961386
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Entity Type | Individual
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Provider Name | LUZVIMINDA REPASO SANTOS M.D.
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Gender | Female
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Dates
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Enumeration Date | 12/26/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 3535 S JEFFERSON AVE STE 107 ALEXIUS BROTHERS, JEFFERSON DIVISION MEDICAL BLDG.
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City | SAINT LOUIS
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State | MO
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Zip | 63118-3907
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Country | US
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Telephone | 314-776-6575
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Fax | 314-776-6818
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Provider Business Mailing Address
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Address Line | 3535 S JEFFERSON AVE STE 107 ALEXIUS BROTHERS, JEFFERSON DIVISION MEDICAL BLDG.
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City | SAINT LOUIS
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State | MO
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Zip | 63118-3907
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Country | US
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Telephone | 314-776-6575
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Fax | 314-776-6818
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | RIC-50
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License Number State | MO
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